This document discusses obstetric emergencies. It defines obstetric emergencies as life-threatening medical conditions that occur during pregnancy, labor, or delivery. Examples include obstetric shock, amniotic fluid embolism, prolapsed cord, ruptured uterus, vasa previa, and shoulder dystocia. Prompt recognition and treatment are essential to limit morbidity and mortality. Management of emergencies prioritizes ABCs (airway, breathing, circulation), IV fluids, monitoring vital signs, blood transfusions if needed, and teamwork. Specific conditions like postpartum hemorrhage, preeclampsia/eclampsia, and thromboembolism are also outlined.

1. OBSTETRICS
EMMERGENCIES

2. •Specific objectives:
•• At the end of class, the student will be
•able to:
•▪ Describe obstetrical emergencies.
•▪ Define obstetrical emergencies.
•▪ List out conditions of obstetrical
•emergencies.
•▪ Identify the signs and symptoms of
•obstetrical emergencies.
•▪ Manage mother with obstetrical
•emergencies.

3. •An emergency is defined as a serious
situation or occurrence that happens
•unexpectedly and demands
immediate action. Prompt recognition
and treatment of
•these emergencies/complications of
pregnancy is essential to limit
morbidity and
•mortality.

4. •Definition
•Obstetrical emergencies are
lifethreatening medical
•Conditions that occur in
pregnancy or during or
•after labour and delivery

5. Management of a pregnant woman is almost
always is an emergency care.
Some conditions are top emergency ,and the
survival of the patient depends on how quickly
,timely and effectively ,does the attendant
personnel react.
The catastrophies always occur, when the:
intervention is late, wrong or inadequate.

6. •Preventionofobstetricemergencies
•It is not possible to prevent or predict all
obstetric emergencies but it is essential
•To recognize early warning signs,reduce
risk factors and have appropriate
support present in anticipation of
obstetrice mergencies.

7. These are the life-saving measures.
Ment to keep the patient alive, to
receive treatment.
IST aids measures.
Kept as a rule of thumb.
The A.B.C

8. A. I.C.U facilities.
B. Secure respiration:
i. Lateral position
ii. Keep patent airway
iii. Suction
iv. O2 supply.
C. Secure I.V line and give fluids
N. saline- Heartman- Ringer lactate.
D. Blood for grouping and X-matching.
include

9. E. Give FRESH blood when necessary. OR
fresh frozen plasma or platelets.
F. Monitor vital signs- R.R- Pulse -B.P
G. Anti-shock measures.
corticosteroids- Sedation –warm patient
Raise foot of bed.
H. Team work.

11. •Obstetrical emergencies may occur
•during active labour are:
•➢Obstetricalshock,
•➢Amniotic fluid embolism,
•➢Presentation and prolapsed of cord,
•➢Rupture of uterus,
•➢Vasa previa,
•➢Shoulder dystocia.

12. •Shock in Obstetrics
•Definition
•• Shock is a condition resulting from
•inability of the circulatory system to
•provide the tissues requirements from
•oxygen and nutrients and to remove
•metabolites.

13. •Classic Clinical Picture of Shock
•• Low blood pressure.
•• Rapid weak (thready) pulse.
•• Pallor.
•• Cold clammy sweat.
•• Cyanosis of the fingers.
•• Air hunger.
•• Dimness of vision.
•• Restlessness.
•• Oliguria or anuria.

14. •Phases of Haemorrhagic Shock
•1.Phase of compensation
•2. Phase of decompensation
•3. Phase of cellular damage and
danger of death

15. •Types and Causes
•1. Haemorrhagic shock
•2. Neurogenic shock
•3. Cardiogenic shock
•4. Endotoxic shock
•5. Anaphylactic shock

16. •Types and Causes continue…
•7. Other causes:
•– Embolism: amniotic fluid, air or
thrombus.
•– Anaesthetic complications
•– Incomplete abortion: leads to
•haemorrhagic and endotoxic shock.
•- Eectopic and rupture uterus

17. Include:
1. Severe abortal haemorrhage and molar
pregnancy.
2. Ruptured Ectopic-Intra-peritoneal
haemorrhage.
3. A.P.H
4. PPH, and post-partum collapse.
HAEMORRHAGIC EMERGENCIES

18. Miscarriage
Different clinical varieties.
Severe bleeding usually in case of inevit. Or
incomp. Miscarriage.
Diagnosis.
Start with A.B.Cs
Give ergometrine, syntometrine or oxytocin.
Remove products from cervix and vagina
manually.
Surgical evacuation of the uterus.

19. Anti-biotic.
Anti-D in rhesus negative.
Counsel about F.P.
In case of molar pregnancy follow up by
HCG for one year.

20. Clinical picture is diagnostic.
Short period of amenorrhea, sudden
onset of sharp lower abdominal pain
followed with collapse.
O/E patient is pale, cold, sweating, rapid
or irrecordable pulse, low or irrecordable
B.P
Abdomen is distended, very tender with
gaurding rigidity and dull on percussion.
Ruptured ectopic with intra-
peritoneal haemorrhage

21. A.B.Cs immediate massive
transfusion.
Urgent laparotmy.
managment

22. Bleeding from birth canal at 24 weeks
and before onset of labor.
The two major causes are:
i.Placenta praevia.
ii.Abruptio placenta.
Placenta praevia:
any placenta which is partially or wholly
situiated in the lower segment (4 types)
Antepartum Haemorrage (A.P.H)

23. The clinical presentation is of a
painless,causeless recurrent,bright red
bleeding.
Clasical management is conservative one
Terminate at 37-38 weeks.
In case of severe bleeding endangering the life
of the mother ,terminate,after
ABCS,resussitation,irrespective of gestational
age.
CS is the most appropriate procedure.

24. Morbid adherence of the placenta is a
serious complication during CIS, so at
least 4 units of blood should be prepared.
In this case (previous scar + placenta
praevia) CIS should be done by senior
obstetrician.
Hystrectomy may be life-saving and hence
patient should be counseled.

25. Massive abruption can easily be
diagnosed clinically.
Predisposing factors may be present.
Hypertensive disease -D.M- chronic
nephritis,folate deficiency-
polyhydramnios.
Signs and symptoms are diagnostic
Abruptio-placenta

26. i) Sudden sharp abdominal pain.
ii) Vaginal bleeding –brownish in color and
watery.
iii) Shock and collapse irrespective of the
revealed bleeding.
iv) Pallor , rapid Thready pulse , low B.P.
v) Rigid, hard and tender uterus

27. The ABCs + enough fresh blood.
Antishock measures.
Urinary catheter.
Stabilize general condition of the patient.
Terminate pregnancy.
Post- partum follow up:
Management:

28. i) Vital signs.
ii) urine output.
iii) Coagulation profile.
iv) Antibiotics.

29. i) Hypofibrinoginaemia.
ii) PPH.
iii) Acute renal failure.
iv) DVT and thrombo-Embolic disorder.
v) SEPSIS.
Complications

30. Bleeding of more than 500 ml in
vaginal delivery or more than one litre
in case of CS.
If not dealt with promptly, it is a major
cause of maternal mortality.
Commonest and more serious is the
atonic one.
Postpartum haemorrhage

31. Predisposing factors for atony are :
i) Grandmultiparity.
ii) Overdist. of the uterus.
iii) Prolonged labor.
iv) Abruptio Placenta.
v) Anaesthesia.
vi)MgSO4 Therapy.

32. Other causes of PPH;
i) Genital tract trauma.
ii) Retained placental tissue.
iii) Placenta preavia .
iv) Uterine inversion.
v) Coagulation disorders.

33. Team work.
Call for senior help.
A.B.Cs.
Rub uterine fundus + Oxytosin +
syntometrine.
Check placenta.
Check for genital tact trauma (good
light)
MANAGEMENT

34. Bi-manual compression of the uterus.
Prepare for surgical intervention (diff.
methods).
Nurse in I.C.U.
Blood products to correct coagulation
defect:

35. • Platelet concentrate—» increase platelet
by(20-25000)
• Cryoprecipitate —»supply fibrinogen ,F vii ,
Xiii (3-10)folds.
• Fresh frozen plasma—»all factors except
platelet.
• Packed red cells —»raise hematocrit(3-4%).

36. 3rd stage of labor begins after delivery
of the fetus till complete delivery of
placenta.
Give syntocinon or ergom. at delivery
of ant. Shoulder.
Clamp the cord immediately-Empty
the bladder.
Look for signs of separation of
placenta;
Active management of 3rd stage
of labor

37. i) Gush of blood.
ii) Elongation of cord.
iii) Rise of fundus of uterus and becoming firm
and globular.

38. Deliver placenta by CCT-And avoid credes
method.
Massage the uterus per abdomen and
squeeze any blood.
Check placenta for completeness and also
membranes.
Check for any genital tract trauma.
Observe for next two hours for any
PPH(4th stage).

39. Uterine rupture
•Uterine
•When happens:
• Within c/s scars
• With excessive use of oxytocin
• In obstructed labour-malpresentation (transverse
•lie, fetus hydrocephalus
• Corneal pregnancy
• Congenital uterine defects
• In high parity
• Following trauma
•Symptoms:
• Uterine tenderness
• Vaginal bleeding
• Abdominal pain released when contractions stop
• Loss of fetal movements
• Signs of shock
•Treatment: laparotomy, hysterectomy if needed

41. Treatment
•manual replacement
•intravascular volume replacement. If the placenta has not
been removed: replace the uterus by applying pressure to
the inverted fundus without removing the placenta and
increasing natural oxytocin.
•If manual replacement succeeds, the placenta can be
manually removed
• uterine contraction assured by massage and oxytocin
infusion. If manual replacement fails,
• When all above measures fail, laparotomy is indicated to
correct the inversion

44. PE is rise of blood pressure and
proteinuria(24 Wks).
Severe PE B.p 160110 or
symptoms:
i) Epig. Pain and vomitting.
ii) Severe frontal headache.
iii) Oliguria.
iv) Blurring of vision, dipolpia, syncopal
attack
Management of severe Pre-
Eclampsia and Eclampsia

45. v) Signs of pulm. Oedema (dyspnea or cyanosis)

46. I.C.U sedation anti-convulsant
Prophylaxis (MgSO4,Diazepam).
Treat hypert. , by Emmergency drugs
like labetalol -hydralazine- Nifedipine).
Termination of pregnancy.
Treatment

47. Comlicate PIH or PE.
Characterized by seizures [D.D from
Epelipsy, cerebral malaria, other medical
condition].
Management is an Emergency
A] I.C.U lateral position patent airway
suction O2 supply catheter
B] Anti-convulsants:
i) MgSO4. ii) Diazepam.
ECLAMPSIA

48. C] Treat hypertension (Diastolic [105-110])
Emergency drugs.
D] Fluid therapy (500 ml) glucose + output 6 hourly.
E] Terminate as soon as patient is stable.
F] INVEST:
-Urine for protein.
-CBC .
-K.F.T _LFT _ .
- coagulation study- O2 saturation
-Imaging; CT---MRIE
] Cont. monitoring vital signs and urine output.

49. Acute pulm oedema
Resp. failure.
CVA
Acute renal failure
DIC
HELLP syndrome
Neurological deficit
Death of fetus
Death of mother
complication

50. •AMNIOTIC FLUID EMBOLISM
•Definition
•• Passage of amniotic fluid into the
•maternal circulation leads to sudden
•collapse during labour but can only be
•confirmed at necropsy.

51. •Risk factors of AFE
•• Advanced maternal age
•• Multiparity
•• Intrauterine foetal death
•• Placenta accreta
•• Polyhydramnios
•• Uterine rupture
•• Maternal history of allergy or atopy
•• Chorioamnionitis
•• Macrosomia

52. •Clinical Picture
•➢ onset is acute
•➢sudden collapse,
•➢cyanosis and severe dyspnoea.
•➢ followed by convulsions and right
side heart
•failure, with tachycardia, pulmonary
oedema and
•blood stained frothy sputum

53. •Laboratory Studies
•A. Arterial blood gas (ABG) levels:
Expect
•changes consistent with
•hypoxia/hypoxemia.
•– Decreased pH levels
•– Decreased PO2 levels
•– Increased PCO2 levels

54. •Laboratory Test conti..
•▪ CBC with platelets
•• Imaging Studies- Chest radiograph
•• Procedures
•– Arterial line to accurately measure blood
pressure
•and to obtain ABG readings
•– Pulmonary artery catheter to monitor
wedge
•pressure, cardiac output, oxygenation, and
•systemic pressures.
•– ECG: evidence of right side heart failure.

55. •Treatment
•• intubation and CPR
•• experienced help, and a resuscitation tray with
•intubation equipment, DC shock, and
•emergency medications.
•• IMMEDIATE MEASURES :
•- Set up IV Infusion, O2 administration.
•- Airway control endotracheal intubation
• maximal ventilation and oxygenation.

56. •Urgent treatment includes:
•➢ Oxygen: endotracheal intubation
•➢Aminophylline: 0.5 gm slowly IV to reduce
•bronchospasm.
•➢Isoprenaline:0.1gm IV to improve pulmonary
•blood flow and cardiac activity.
•➢Digoxin and atropine: if central venous
•pressure is raised and pulmonary secretions
•are excessive.
•➢Hydrocortisone: 1 gm IV followed by slow IV
•infusion.

57. •Complications
•• Pulmonary oedema
•• Left heart failure
•• DIC

58. THROMBOEMBOLIC DISEASE N
OBSTTET & GYNAEC

59. Thrombosis and
thromboembolism are common
risk factors in obstet and
gynecol.
They are leading causes of
maternal mortality (UK&USA).
Pregnancy increases the risk of
thromboembolism 6 folds and
c/s 10-20 folds.

60. Pulmonary embolism(PE
•High index of suspicious is needed.
•Breathlessness and pleuretic pain of
sudden onset should be
investigated.
•Cough and haemoptysis.

61. Massive PE may present with
central chest pain and collapse.
Examination may reveal ;
tachycardia,tachypnia,raised
JVP,loud second heart sound
and right ventricular heave.
With pulmonary infarction ,a
pleural rub and fever may be
present.

62. DIAGNOSIS
A. ) DVT;
 objective diagnosis is vital .
 Venography is diagnostic .
 Doppler U.S more convenient and
less invasive .
B. ) PE ;
 Chest X -ray
 ECG :
may be normal except for

63. In massive PE it may show ® axis
deviation ,® bundle branch block and
peaked P-wave in lead II.
 Arterial blood gases .
 O2 saturation by pulse oximeter .
 Perfusion scan ( technetium 99) .
 Ventilation scan (Xenon-133)
 Pulmonary angiography for localisation of
thrombus .

64. TREATMENT
A. . Heparin in high doses (40,000 I.V / 24
Hour ).
. Adequate dose that prolong APTT by
1,5 -2 time for at lest 5 days .
. Platelet count 5-7 days latter
B. LMWH : dose is based on weight (mg
/kg body weight ) .
C. Following acute phase management ,
thromboprophylaxis is carried for the rest
of pregnancy and puerperium .

65. 1 Hyperemesis gravidarum:
Incidence 0.1-1%.
Intractabale vomitting associated
with dehydration,electrolyte
imbalance and ketonuria.
Liver and thyroid may be affected.
Wernick’s encephalopathy is a
serious complication.
Hyponatraemia may cause lethargy,
seizures and respiratory arrest.

66. The encephalopathy is due to
thiamine(vit.B1)deficiency, and may be
precipitated by glucose infusion.
Other vit. Like B12 and B6 are also
deficient.
Wernick’s encephalopathy is associated
with 40% fetal loss.
I.U.G.R may complicate hyperemesis.

67. Management:
Early and aggressive treatment hosp. Admission.
I.V fluid therapy, adequate + electrolyte replacement.
Give normal saline or Heartman’s solution and avoid
glucose.
Monitor and titrate electrolytes daily (Na and K).
Thiamine (B1)is given orally t.d.s or 1.v weekly.
Anti-emetics: cyclizine- promethazine, metoclopramide.
Coitico-steroids and termination in resistant cases.

68. General conditions affecting pregnancy:
•Appendicitis (1:1000-1500 pregnancies)
•Renal colic
•Hepatic colic-cholestasis!
•Ovarian torsion
•Uterine fibroids
•Ovarian large cysts
•Sub-arachnoid Haemorrhage (SAH)
•Diabetic comas
•Asthma
•Heart conditions
•Drug poisoning
•Injuries
•In all medical conditions in pregnancy, the treatment plan
•should involve a medical/surgical specialist together with an
•obstetrician! Only holistic, multi-disciplinary care provide the
•best treatment to both, mother and a fetus!

69. COMPLICATIONS OF
BLOOD TRANSFUSION
1-Transmision of disease i.e.:
Viral: HIV Hepatitis;
Malaria Syphilis bacterial.
2-pyorogenic reaction.
3-incompatibility reaction.
4-haemolytic reaction .
5-allergic reaction.
6-citrate toxicity.
7-hyper-kalaemia,
8-Circulatery over load.
9-Air embolism
10-micro-aggerigation,
11-hypo-thermia..
12-metabolic acidosis